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I <3 My Rheumy!

In the spirit of Mom With A Stethoscope’s recent anti-rant (read back through all the posts, not just the summary that’s linked) I’d like to say: I love my new rheumatologist.

There is a plan.

I get to know what that plan is.

I am comfortable talking to her.

She listens to me.

She looks at the paperwork I fill out for her.

She advocated not paying a bill.

She doesn’t spring surprises on me.

She gives me information (I don’t have to pry it out of her).

Once she considers me stable, I won’t have to see her as frequently.

She’d like to reduce my number of meds.

She gives me hope that I can get my life back.

“What,” you may ask, “led to this outburst?” I had another follow-up with my rheumatologist yesterday. She is wonderful.

Before ever entering the exam room, she looks at the two-page questionnaire that’s required at every visit. What takes place during the visit is based largely on the information provided on that questionnaire. This has been true at every follow-up appointment, not just yesterday. (It seems like a no-brainer, but I’ve seen doctors who don’t do this.)

Yesterday I was feeling pretty good. She could tell. I told her that I hadn’t expected the methotrexate to work so quickly, and she replied even though it can take up to six weeks, there should be some response in two weeks. When I held up my hands to show that the swelling has in my hands has gone down enough that I can wear my rings, she admitted that she hadn’t expected it to be that dramatic.

I told her that because of our car wreck last summer, my medical insurer is denying all my claims and telling me to submit those claims to auto insurance (even routine lab work ordered by the rheumy). She advised me not to pay the bills myself. Insurance isn’t likely to reimburse me if I pay a claim they’ve denied, but her office and the lab will jump through the hoops necessary to get payment so long as the bills are unpaid.

If the mtx continues to cause nausea, she’ll switch me to injectible. Her idea, not mine. I really think she would have made the switch immediately if I’d said, “oh good, let’s try that.” It gets better every week, so I’m okay sticking with the pills for now. Immediate response to little details is really nice.

There is a plan for my treatment. She actually said, “Here’s the plan…” My head would be spinning, and I honestly don’t know if I could take it all in if I hadn’t done so much reading about RA. But I have, so it works. If I hadn’t, I think I could say, “Whoa, slow down,” if I needed to, and she’d back up and provide more detail.

Yesterday she mentioned paving the way for insurance to approve a biologic. She did that last month, too. The idea of a BRM terrifies me, so I appreciate having time to get used to the idea. No surprises. Hopefully, if the time ever comes, I’ll be ready for that step.

She doesn’t want me taking so many pills. Once we’re both happy that everything is well controlled, we’ll see about decreasing the number of medicines I need to take.

She understands my frustration with monthly appointments. Since I expressed this to the nurse, not the doctor, it means that the nurse is listening and she communicates the extra information to the doctor. Once I’m stable – doing well and not changing doses – quarterly follow-up will be okay. Not so very long ago, I would have been appalled at the idea of four doctor’s appointments in a single year. One appointment every-other-year was frequent enough. Now I’m looking forward to only four appointments a year.

She increased my methotrexate to 15 mg. The goal isn’t just “pretty good” or “mostly okay” or “much better than before.” The goal is NED. No evidence of disease. She’s the only one who’s ever said that’s possible. It gives me hope.

Hmmm, would like to hear her idea of what “no evidence of disease” is. My rheumy is a bit like yours but not to that degree. I think her idea of “no evidence” is no swelling. Perhaps I threw her off by having taken my prednisone at night for some time though, which did help with morning stiffness. I tried to keep reminding her but maybe it just didn’t stick. I think she’s not a believer of following ESR or CRP, etc. Not big on xrays, doppler or MRI’s etc. although all of that adds to the cost of care.

My rheumy isn’t wedded to lab results, either. This is good, since the highest my ESR has ever been is 4. A couple times it was 1. I think this rheumatologist likes the puzzle of “an atypical presentation.” I enjoy puzzles myself, but don’t especially like being one! Anyhow, since there’s no joint damage visible on x-rays, she thinks that zero pain and swelling is a reasonable goal.